197609621-3-21-2023-31-AS-TAGD-CUBNFQ-20230802102552

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609621
Report Date: 03/21/2023
Date Signed: 03/21/2023 03:07:06 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/20/2023 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20230320154213

FACILITY NAME:	GOLDEN ASSISTED LIVING		FACILITY NUMBER:	197609621
ADMINISTRATOR:	LOPEZ, MONIQUE		FACILITY TYPE:	740
ADDRESS:	14060 ASTORIA ST		TELEPHONE:	(818) 367-1947
CITY:	SYLMAR	STATE: CA	ZIP CODE:	91342
CAPACITY:	128	CENSUS:	DATE:	03/21/2023
		UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Monique Lopez - Administrator		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff are not adequately addressing outbreak of scabies at the facility.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced initial complaint visit at this facility to investigate the above allegations. LPA met with administrator Monique Lopez and explained the reason for the visit.

LPA conducted physical plant tour at 9:12 AM, requested copy of facility documents relevant to the investigation at 934 AM and interviewed staff and residents between 10:00 AM to 1:00 PM. Regarding the allegation that the Staff are not adequately addressing outbreak of scabies at the facility, LPA's interview with Resident #1 (R1) revealed that this happened sometime in January of this year. LPA's record review at around 1:05 PM revealed that R1 was admitted at the facility on 03/10/23. LPA's interview with staff between 10:00 AM to 1:00 PM revealed that there was no case of scabies at this facility for the last three (3) years. The allegation is therefore deemed unfounded at this time. A finding of unfounded means that the allegation is either false, could not have happened, and/or is without a reasonable basis. Exit interview conducted. Copy of this report issued.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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